National specialty trends in billable diagnostic ultrasound in the Emergency Department setting : analysis of Medicare claims data ☆ , ☆ ☆

Article history: Received 22 July 2014 Received in revised form 28 August 2014 Accepted 1 September 2014 Available online xxxx Objective: To assess recent national specialty trends in the use of diagnostic ultrasound (US) services in the Emergency Department (ED) setting. Methods:We searched aggregated 1998-2012Medicare Part B Master Files for ED diagnostic US studies, excluding cardiac and ophthalmic examinations. Studies were classified by body part and interpreting specialty. Subsequent analysis was performed for higher-volume services rendered by emergency physicians for which discrete codes were present longitudinally for complete vs limited examinations. National trends were analyzed. Results: From 1998 to 2012, paid ED US studies interpreted by radiologists, emergency physicians, and all other physicians increased by 332% (from 221 712 to 735 858 examinations), 4454% (from 561 to 24 992), and 251% (from 26 961 to 67 787), respectively. The fraction of ED US examinations interpreted remained around 90% for radiologists, increased from0.2% to 3% for emergency physicians, and decreased from11% to 8% for other physicians. The fraction of complete abdominal and complete retroperitoneal studies interpreted by emergency physicians remained less than 1% from 1998 through 2012. However, emergency physicians experienced disproportionate growth in limited examinations (from 1% to 9% for abdominal studies and from b1% to 20% for retroperitoneal studies). Likewise, the fraction of (typically targeted) chest studies interpreted by emergency physicians increased from less than 1% to 63%. Conclusion: From 1998 to 2012, there was substantial growth in ED US studies for Medicare beneficiaries interpreted by radiologists and emergency physicians alike. Formore commonly performed services distinguishable as complete vs limited in nature, growth in services by emergency physicians was most dramatic for less complex services. © 2014 Elsevier Inc. All rights reserved.